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Editor,—We were interested to read the recent article by Lee et al.1 Of course, it is not surprising that children with cleft lip and palate have growth failure in infancy, especially with their feeding difficulties. However, follow up in this study was only to a mean of 25.5 months.1 Growth failure is common in children with cleft lip and palate and is related to the type of cleft, as well as age and sex.2 Some children with cleft palate and especially those combined with an additional midline cleft lip may be part of holoprosencephaly complex and have hypothalamic pituitary deficiency, there being no other dysmorphic features.3However, growth hormone secretion has little influence on growth in early childhood.4 Growth may be normal in children with pituitary deficiency until approximately 2 years of age. In addition, children with midline defects may have an evolving endocrinopathy with pituitary deficiencies only appearing in later childhood.5Moreover, growth hormone deficiency has been described as 40 times more common in children with cleft lip and palate.6 We believe that although early catch-up growth is undoubtedly important, growth of children with cleft palate should continue to be monitored throughout childhood.
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